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Finerenone Across the Cardiovascular-Kidney-Metabolic Continuum: From Mechanistic Rationale to Clinical Positioning-A
Jacek Kubica1,2, Aldona Kubica1,2, Jakub Ratajczak1
1Collegium Medicum, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland.
Journal of Clinical Medicine
|May 13, 2026
Summary
Finerenone effectively reduces cardiorenal risk in patients with cardiovascular-kidney-metabolic syndrome, including those with diabetic chronic kidney disease and heart failure. This mineralocorticoid receptor antagonist targets inflammation and fibrosis, improving outcomes beyond standard treatments.
Area of Science:
- Cardiology
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Cardiovascular-kidney-metabolic (CKM) syndrome links obesity, type 2 diabetes, chronic kidney disease (CKD), and heart failure via shared pathways like inflammation and fibrosis.
- Mineralocorticoid receptor overactivation drives progressive cardiac and renal injury, persisting even with renin-angiotensin system blockade.
- Finerenone, a selective mineralocorticoid receptor antagonist, offers a targeted approach to mitigate residual cardiorenal risk.
Purpose of the Study:
- To review the mechanistic basis and clinical evidence for finerenone's efficacy across the CKM spectrum.
- To evaluate finerenone's role in managing cardiorenal risk in patients with CKD and type 2 diabetes.
- To assess finerenone's impact on heart failure with mildly reduced or preserved ejection fraction.
Main Methods:
- Review of experimental data on finerenone's anti-inflammatory and anti-fibrotic effects.
- Analysis of proteomic and translational studies suggesting synergy with SGLT2 inhibitors.
- Examination of pivotal randomized trials (CKD/T2D) and specific heart failure trials (FINEARTS-HF).
Main Results:
- Finerenone demonstrated significant reductions in kidney disease progression and major cardiovascular events in patients with CKD and type 2 diabetes.
- The FINEARTS-HF trial showed finerenone reduced worsening heart failure events in patients with heart failure with mildly reduced or preserved ejection fraction.
- Pooled analyses and meta-analyses confirmed consistent benefits across diverse cardiorenal phenotypes.
Conclusions:
- Finerenone is a key therapeutic option for CKM management, particularly in diabetic CKD and specific heart failure populations.
- Its primary benefit lies in addressing residual inflammatory and fibrotic risks beyond conventional therapies.
- Future directions include earlier recognition of CKM phenotypes and wider adoption of pathway-oriented combination therapies.
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